Effective promotion of patient safety programs-and therefore patient safety improvement-remains hampered by the paucity of evidence on the factors associated with successful implementation of patient safety initiatives and on the effectiveness of comprehensive patient safety programs for reducing avoidable injuries. This project aims to improve patient safety, safety culture, and outcomes in healthcare by developing national evidence on the relationship between market and organizational characteristics, organizational safety culture, and patient safety. Expanding upon findings and methodological techniques proven through ongoing work at Stanford, we specifically aim (1) to validate further the Patient Safety Cultures in Healthcare Organizations survey instrument, (2) to understand the relationship between hospital characteristics and practices, safety culture, and patient outcomes, and (3) to improve safety culture by preparing executives to explore the realities of front-line work in their institutions. A collaboration of Stanford's Center for Health Policy & Center for Primary Care and Outcomes Research (CHP/PCOR), the Patient Safety Center of Inquiry at VA Palo Alto Health Care System, the Joint Commission for Accreditation of Health Care Organizations, the Naval Postgraduate School, participating hospitals, and others (the "Patient Safety Consortium") will achieve these aims by measuring safety culture in a diverse, nationwide sample of hospitals; assessing the relationship between individual and hospital characteristics and safety culture; determining the relationship between safety culture and aspects of healthcare financing and organization, such as managed care activity and hospital competition; comparing safety culture in hospitals to high-reliability organizations in non-medical, high-hazard industries; determining the relationship between safety culture, other potential determinants of patient safety, and patient costs and outcomes; tracking changes in safety culture and these relationships over time; and implementing and evaluating a practical intervention designed to improve safety culture.